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dvt 1.pptx

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    Deep vein

    thrombosis

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    Semisolid coagulum within fowing blood invenous system

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    Patient actorsAge

    Obesity

    Varicose veinsImmobility

    Pregnancy Puerperium

    High-dose oestrogen

    therapyPrevious V! or P"

    !hrombophilia

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    iseaseSurgery# !rauma

    $alignancy

    Heart ailure%ecent $I

    Paralysis o lowerlimb

    Inection

    Infammatory boweldisease

    &ephrotic syndrome

    Polycythaemia

    Paraproteinaemia

    P&H'eh(et)s disease

    Homocystinaemia

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    !hrombophiliaCongenital

    e*ciency o anti-thrombin III# protein +

    or protein S

    Antiphospholipidantibody or lupusanticoagulant

    ,actor V eiden genedeect or activatedprotein + resistance

    ys*brinogenaemias

    Acquired

    Antiphospholipidantibody or lupusanticoagulant

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    +linical eaturesPain and swelling o

    cal

    %edness

    "ngorged super*cialveins

    cramp in the lower

    cal that persists or

    several days and

    becomes moreuncomortable as time

    progresses.

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    Pittng edema

    ilated veins

    Sti/ cal!ender vein course

    Homans sign

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    +linical eaturesFeatures of PE

    $assive - yspnea# syncope# hypotension#

    cyanosissmall - situated distally near the pleura-

    pleuritic pain# cough# or hemoptysis

    0classic0 signs- tachycardia# low-grade ever#

    nec1 vein distention# and an accentuated P 2

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    Venous gangrene

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    %uptured ba1er)s cyst#

    +al muscle haematoma#%uptured plantaris muscle#

    !hrombosed popliteal aneurysm

    Arterial ischemia

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    Diagnosis

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    Clinical variable Score

    Active cancer 3Paralysis # paresis# recent cast 3

    'edridden or4 5 days # ma6or surgery

    7 32 wee1s

    3

    !enderness along deep veindistribution

    3

    "ntire leg swelling 3

    8nilateral cal swelling 45 cm 3

    Pitting edema 3

    +ollateral super*cial non varicose veins 3

    Alternate dia nosis at least li1el as -2 9: # $ 3#2 H;5

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    Venous 8S

    Absence o [email protected] on crosssection

    ,ailure to oppose walls dueto passive distension

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    2 !hrombus

    homogenous # lowechogenecity

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    5 +al compression blunts

    doppler fow signal

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    Management

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    ProphylaisLowB young# minor illness # operations

    lasting 75:

    ModerateB 4 C: or with a debilitating illnesswho are to undergo ma6or surgery.

    igh B 3> 4C: who have seriousaccompanying medical conditions= +VA $I>#

    2>ma6or surgery with an additional ris1actor =past history o venousthromboembolism or 1nown malignantdisease.>

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    High-ris1 general surgery-$ini-8,H or$EH

    !horacic surgery- $ini-8,H FIP+

    +ancer surgery - $EH#consider 3 month oprophylais

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    !otal hip replacement#

    total 1nee replacement# hipracture - $EH#ondaparinu

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    &eurosurgery - IP+

    &eurosurgery or brain tumor-$ini-8,H or$EH# F IP+ Fpredischarge venous

    ultrasonography$edically ill patients- $ini-8,H or$EH

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    Anticoagulationcontraindicated - IP+

    ong-haul air travel - $EHor very high-ris1 patients

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    !reatment G

    anticoagulationInitiation G 8,H # $EH #ondaparinu

    Proven HI! G direct thrombininhibitor G agatroban #

    lepirudin # bivalirudin$aintenance G wararin

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    AP!! G 2 -5

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    iv bolus - :::-3:::: 8

    ollowed by inusion 3:::-3::8hr

    Short t J

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    ,ondaparinu G anti Ka

    pentasaccharide&o lab monitoring no HI!

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    Eararin

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    Initiated in mg dose

    !arget I&% 2. =2-5>

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    urationP" ater surgery# trauma#

    or estrogen eposure-have a low rate orecurrence ater 5GLmonths oanticoagulation.

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    V! isolated to an upperetremity or cal that has been

    provo1ed by surgery# trauma#estrogen# or an indwelling centralvenous catheter or pacema1er- 5

    months o anticoagulationsuMces.

    ,or provo1ed proimal leg V!

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    cancer and V!"# 5GL monthso $EH as monotherapywithout wararin and tocontinue anticoagulation

    inde*nitely unless the patientis rendered cancer-ree.

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    Idiopathic# unprovo1ed

    V!"# =incl long-haul airtravel> anticoagulationor an inde*nite durationwith a target I&% between2 and 5

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    .moderate or high levels oanticardiolipin antibodies -inde*nite-durationanticoagulation even i the

    initial V!" was provo1ed bytrauma

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    ,ibrinolysis

    rtPA

    Iliac vein thrombosis

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    IV+ *lters

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    Active bleeding

    %ecurrent venousthrombosis despiteanticoagulation